A convolutional neural network architecture for the recognition of cutaneous manifestations of COVID-19.

During the COVID-19 pandemic, dermatologists reported an array of different cutaneous manifestations of the disease. It is challenging to discriminate COVID-19-related cutaneous manifestations from other closely resembling skin lesions. The aim of this study was to generate and evaluate a novel CNN (Convolutional Neural Network) ensemble architecture for detection of COVID-19-associated skin lesions from clinical images. An ensemble model of three different CNN-based algorithms was trained with clinical images of skin lesions from confirmed COVID-19 positive patients, healthy controls as well as 18 other common skin conditions, which included close mimics of COVID-19 skin lesions such as urticaria, varicella, pityriasis rosea, herpes zoster, bullous pemphigoid and psoriasis. The multi-class model demonstrated an overall top-1 accuracy of 86.7% for all 20 diseases. The sensitivity and specificity of COVID-19-rash detection were found to be 84.2 ± 5.1% and 99.5 ± 0.2%, respectively. The positive predictive value, NPV and area under curve values for COVID-19-rash were 88.0 ± 5.6%, 99.4 ± 0.2% and 0.97 ± 0.25, respectively. The binary classifier had a mean sensitivity, specificity and accuracy of 76.81 ± 6.25%, 99.77 ± 0.14% and 98.91 ± 0.17%, respectively for COVID-19 rash. The model was robust in detection of all skin lesions on both white and skin of color, although only a few images of COVID-19-associated skin lesions from skin of color were available. To our best knowledge, this is the first machine learning-based study for automated detection of COVID-19 based on skin images and may provide a useful decision support tool for physicians to optimize contact-free COVID-19 triage, differential diagnosis of skin lesions and patient care.

Clinical and Metabolic Characteristics in Hidradenitis Suppurativa - An Indian Perspective.

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent follicular disorder affecting apocrine gland bearing areas such as axillae, inframammary area and groin. Significant association of HS with metabolic derangements such as hypertension, obesity, hyperlipidemia and hyperinsulinemia has been found. There is dearth of literature on epidemiological and metabolic profile of HS in Indian subjects. Aim: The aim of this study is to assess abnormalities in the levels of fasting blood glucose, serum insulin, and lipid profile in patients with HS. Primary Objective: To assess the frequency of abnormal levels of fasting blood sugar, serum insulin and lipid profile in patients with HS. Secondary objectives: To assess the frequency of hypertension, raised basal metabolic index, polycystic ovarian syndrome, follicular disorder, erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) in patients with HS and to assess the severity of of clinical presentation HS using Hurley staging system. Methodology: This is a retrospective record based study. Records of clinically diagnosed patients of HS, aged > 18 years fulfilling the inclusion and exclusion criteria were analysed. Results: Total 30 patients were recruited with 1:1 male to female ratio. Five (16.67%) cases fulfilled NCEP ATP III criteria for the diagnosis of metabolic syndrome. Statistically significant association was observed between severity of HS, in younger age group (<20 years), moderate to severe BMI, fasting serum insulin, fasting total cholesterol and raised ESR. Limitations: This is retrospective, hospital record based study with small sample size. Conclusion: Holistic management of HS should be individualized according to need of patient and it should be combined approach including dermatologist, plastic surgeon, psychiatrist and dietician. We recommend an initial screening for derangements in metabolic profile in these patients for more effective management and preventing long term cardiovascular complications.

Evaluation of clinical efficacy and laboratory indicators of non-cultured epidermal cell suspension and hair follicle cell suspension in surgical management of stable vitiligo: A randomized comparative trial.

BACKGROUND: Non-cultured epidermal cell suspension (ECS) and hair follicle cell suspension (HFCS) are well-established methods of surgical treatment of stable vitiligo. AIMS: The aim of the present study was to compare the laboratory indicators and clinical efficacy of ECS and HFCS in the treatment of stable vitiligo. METHODS: This was a single centre, open-labeled randomized trial. Vitiligo patches from 74 patients were randomized to receive either ECS or HFCS. Both cell suspensions were analyzed for total cell count, cell viability and melanocyte count. Percentage re-pigmentation was assessed at regular intervals for 36 weeks. RESULTS: The percentage re-pigmentation with ECS was significantly higher than HFCS at week 4 (p = .01) and week 16 (p = .03) however, no difference was observed at weeks 24 (p = .38) and 36 (p = .05). Forty-seven patients completed the study follow-up duration and excellent re-pigmentation (>90%) was achieved in 61.7% and 53.2% and complete re-pigmentation (100%) was observed in 6.4% and 12.8% of participants using ECS and HFCS, respectively. Significantly higher cell yield (p < .01) and percentage of HMB45+ melanocytes (p = .01) were obtained using ECS. No difference was noted in the percentage of viable cells or S100 + melanocytes. CONCLUSION: The median cell yield was eight times higher in ECS than in HFCS with a significantly higher percentage of HMB45+ melanocytes in the former group. The median percentage of re-pigmentation in both groups was 90% at the end of 36 weeks. ECS provides faster re-pigmentation; however, both ECS and HFCS have comparable safety and efficacy over a longer duration of follow-up.

Pemphigoid gestationis: a rare pregnancy dermatosis treated with a combination of IVIg and rituximab.

Pemphigoid gestationis is a rare autoimmune subepidermal bullous dermatosis occurring during pregnancy and post partum. A 32-year-old woman developed itchy urticarial wheals over the trunk and extremities at 6 months of gestation. This was not controlled with antihistamines, and 2 months later, the patient developed multiple vesiculobullous lesions. The patient had an exacerbation 3 weeks post-delivery. She did not go into remission for 6 months post partum despite treatment with prednisolone 40 mg/day, doxycycline 100 mg two times per day and dapsone 100 mg/day. The patient went into remission following treatment with three courses of intravenous immunoglobulin 2 mg/kg/course and 2 doses of rituximab 1 g at a 2-week interval.

Restrictive Dermopathy - A Rare Congenital Skin Disorder.

Restrictive dermopathy is a rare, autosomal recessive, lethal congenital skin disorder. This congenital genodermatosis could be mistaken for various other similar skin disorders. Diagnosis is a must in the context of genetic counseling for the subsequent pregnancy. We herein report a preterm male neonate with restrictive dermopathy, with additional feature of multiple bone fractures.

Comparison of efficacy of noncultured hair follicle cell suspension and noncultured epidermal cell suspension in repigmentation of leukotrichia and skin patch in vitiligo: a randomized trial.

BACKGROUND: Vitiligo manifests as hypo- to de-pigmented macules, which are sometimes associated with leukotrichia. For complete cosmetic improvement, the repigmentation of leukotrichia is an important component. METHODS: This randomized controlled trial included patients with stable vitiligo with leukotrichia. Two vitiligo patches in each patient were randomized to receive either of the two procedures. The patients were followed up for 9 months posttransplantation. The efficacy of hair follicle cell suspension (HFCS) with epidermal cell suspension (ECS) in repigmentation of leukotrichia and skin in vitiligo was compared. RESULTS: A total of 20 patients underwent the procedure, and 19 completed the follow-up. The area of the vitiligo patch and the number of leukotrichia in the patches were comparable between the two groups. There was a significant difference in the mean ± S.D. number of cells transplanted between the two groups (5.06 × 105 in HFCS vs. 39.8 × 105 in ECS, P < 0.0001). The percentage viability of cells and proportion of melanocytes were comparable between the two groups. A total of 10 patients in HFCS and eight patients in ECS had repigmentation of leukotrichia. The mean ± S.D. percentages of depigmented hair showing repigmentation at nine months were 7.42 ± 11.62% in HFCS and 11.42 ± 17.90% in ECS (P = 0.4195), whereas the mean ± S.D. percentage repigmentation of vitiligo patches was 61.58 ± 42.68% in HFCS and 78.68 ± 30.03% in ECS (P = 0.1618). CONCLUSIONS: The mean number of cells transplanted in the HFCS group was about eight times less than those in ECS. ECS was better than HFCS in repigmentation of leukotrichia and vitiligo, although the difference was not statistically significant.